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Hull ML. Critical Examination of Methods to Determine Tibiofemoral Kinematics and Tibial Contact Kinematics Based on Analysis of Fluoroscopic Images. J Biomech Eng 2024; 146:110801. [PMID: 38959087 DOI: 10.1115/1.4065878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 07/02/2024] [Indexed: 07/05/2024]
Abstract
Goals of knee replacement surgery are to restore function and maximize implant longevity. To determine how well these goals are satisfied, tibial femoral kinematics and tibial contact kinematics are of interest. Tibiofemoral kinematics, which characterize function, is movement between the tibia and femur whereas tibial contact kinematics, which is relevant to implant wear, is movement of the location of contact by the femoral implant on the tibial articular surface. The purposes of this review article are to describe and critique relevant methods to guide correct implementation. For tibiofemoral kinematics, methods are categorized as those which determine (1) relative planar motions and (2) relative three-dimensional (3D) motions. Planar motions are determined by first finding anterior-posterior (A-P) positions of each femoral condyle relative to the tibia and tracking these positions during flexion. Of the lowest point (LP) and flexion facet center (FFC) methods, which are common, the lowest point method is preferred and the reasoning is explained. 3D motions are determined using the joint coordinate system (JCS) of Grood and Suntay. Previous applications of this JCS have resulted in motions which are largely in error due to "kinematic crosstalk." Requirements for minimizing kinematic crosstalk are outlined followed by an example, which demonstrates the method for identifying a JCS that minimizes kinematic crosstalk. Although kinematic crosstalk can be minimized, the need for a JCS to determine 3D motions is questionable based on anatomical constraints, which limit varus-valgus rotation and compression-distraction translation. Methods for analyzing tibial contact kinematics are summarized and validation of methods discussed.
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Affiliation(s)
- Maury L Hull
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616; Department of Mechanical Engineering, University of California Davis, Davis, CA 95616; Department of Orthopaedic Surgery, University of California Davis, Davis, CA 95616
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Tanifuji O, Mochizuki T, Sato T, Watanabe S, Omori G, Kawashima H. Mobile medial pivot (lateral slide)-type total knee arthroplasty exhibited different motion patterns between under anaesthesia and weight-bearing condition. Knee Surg Sports Traumatol Arthrosc 2024; 32:1298-1307. [PMID: 38504507 DOI: 10.1002/ksa.12147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Total knee arthroplasty (TKA), which has medial pivot and mobile-bearing mechanisms, has been developed and clinically used. However, the in vivo dynamic kinematics of the mobile medial pivot-type TKA (MMPTKA) is unclear. This study analysed the in vivo kinematics of MMPTKA in weight-bearing and nonweight-bearing conditions. METHODS The study included 10 knees that underwent primary TKA using MMPTKA. After TKA, lateral view radiographs of the knee in full extension, 90° of flexion and passive full flexion were taken under general anaesthesia in the nonweight-bearing condition. At least 6 months postoperatively, knee motion during squatting from a weight-bearing standing position was observed using a flat-panel detector and analysed using the three-dimensional-to-two-dimensional image registration technique. RESULTS Under anaesthesia: in passive full flexion, the anteroposterior (AP) locations of the femoral component's medial and lateral distal points were 10.2 and 16.0 mm posterior, and the rotational angles of the femoral component's X-axis (FCX) and insert were 8.1° external rotation and 18.5° internal rotation to full extension, respectively. Squatting: the AP translations of the femoral component's medial and lateral most distal points were 2.2 and 6.4 mm, and the rotational angles of the FCX and insert were 5.7° and 1.6° external rotation, respectively. Significant differences were observed in the AP translation of the femoral component's medial and lateral most distal points and changes in the insert's rotational angle when comparing under anaesthesia and squatting. CONCLUSIONS The kinematics of the insert in MMPTKA was significantly influenced by loading and muscle contraction. The femoral component exhibited substantial external rotation and posterior translation under anaesthesia, which may contribute to achieving an optimal range of motion. The insert remained relatively stable during squatting and minimal rotation was observed, indicating good stability. MMPTKA was expected to demonstrate rational kinematics by incorporating mobile and medial pivot mechanisms. LEVEL OF EVIDENCE Level IV, prospective biomechanical case series study.
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Affiliation(s)
- Osamu Tanifuji
- Department of Regenerative and Transplant Medicine, Division of Orthopaedic Surgery, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan
- Department of Orthopaedic Surgery, Saiseikai Niigata Kenoh Kikan Hospital, Niigata, Japan
| | - Tomoharu Mochizuki
- Department of Regenerative and Transplant Medicine, Division of Orthopaedic Surgery, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Satoshi Watanabe
- Department of Orthopaedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Go Omori
- Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Hiroyuki Kawashima
- Department of Regenerative and Transplant Medicine, Division of Orthopaedic Surgery, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan
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Hu M, Xiang S, Xu H, Wang Y, Lv C, Zhang H. Equivalence of clinical and radiological outcomes in cruciate-retaining and cruciate-substituting total knee arthroplasty with medial pivot knee: A comparative study. Heliyon 2023; 9:e22741. [PMID: 38213584 PMCID: PMC10782168 DOI: 10.1016/j.heliyon.2023.e22741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024] Open
Abstract
Introduction Total knee arthroplasty (TKA) has been recognized as the most efficacious surgical intervention for individuals suffering from advanced arthritis; however, there is ongoing debate on the technical details of the procedure. It remains unknown whether preservation of the posterior cruciate ligament (PCL) significantly affects the mid-to long-term performance of ADVANCE® medial-pivotal (AMP) knee implants to enhance patient satisfaction. The hypothesis of this study was to investigate whether the preservation of the PCL has a substantial impact on the functional outcomes of medial pivot (MP) implants in patients undergoing TKA. Therefore, this study aimed to compare the midterm clinical and radiographic outcomes of cruciate-retaining (CR) and cruciate-substituting (CS) TKA using MP prostheses. Methods We included 376 consecutive patients who underwent unilateral TKA between January 2011 and April 2014. Follow-up evaluations were conducted in April 2021. After propensity score matching analysis, clinical and radiological outcomes and complication rates were compared between patients in the CR and CS groups. Results The postoperative outcomes in the two groups significantly improved the preoperative conditions of the patients (all p > 0.05). The postoperative outcomes (WOMAC score, p = 0.517; KSS, p = 0.107; KSFS, p = 0.240; ROM, p = 0.795; FJS, p = 0.822) and radiographic outcomes (preoperative FTA, p = 0.997; postoperative FTA, p = 0.646; aLDFA, p = 0.094; aMPTA, p = 0.970; PTS, p = 0.243) were comparable between the two groups. The complication and revision rates between the groups were not statistically significant (p = 0.34). The Kaplan-Meier cumulative survival of patients in the CRTKA and CSTKA groups was 100 % and 98.6 %, respectively. Conclusions This study supports the hypothesis that when MP prostheses are used, both CR and CS procedures achieve equally good mid-to long-term clinical and radiographic outcomes and complication rates. These findings suggest that PCL preservation may not significantly affect the overall performance of MP implants in patients undergoing TKA.
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Affiliation(s)
| | | | - Hao Xu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yingzhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chengyu Lv
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Karahan M, Acar E, Serarslan U, Gültekin A. Medial pivot total knee arthroplasty: Mid-term results. Acta Orthop Belg 2023; 89:97-102. [PMID: 37294991 DOI: 10.52628/89.1.10252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aims to evaluate the mid-term results of patients who underwent medial pivot total knee arthroplasty at a single center. A total of 304 knees of 236 patients (40 males, 196 females; mean operation age and standard deviation : 66,64 ±7,09 years; range, 45 to 82 years) treated with medial pivot total knee prosthesis in our center between January 2010 and December 2014 were retrospectively analyzed. The American Knee Society Score, Oxford Knee Score, and especially flexion angles were recorded during pre- and postoperative follow-up. Of the operated knees, 71.2% were unilateral and 28.8% were bilateral. The mean follow-up was 79.30±14.76 months. The postoperative results with the Functional Score, Knee Score, Oxford Score, Total Knee Society Score, and flexion angles were significantly higher compared to baseline (p<0.01). All postoperative scores were significantly lower inpatients aged ≥65years, compared to those aged <65 years (p<0.01). In patients who underwent resection of anterior and posterior the cruciate ligaments, only the mean flexion angles were found to increase (p<0.01). Our study results suggest that medial pivot knee prostheses are reliable in the mid-term and provide favorable results in terms of function and patient satisfaction. Level of Evidence: Level IV retrospective study.
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Yoshioka T, Okimoto N, Sawa M, Asano K, Obayashi K, Kawasaki M, Majima T. In Vivo Postoperative Motion of Fixed and Mobile Medial Pivot Knees Under Weight-Bearing Conditions after Cruciate-Sacrificing Total Knee Arthroplasty. J NIPPON MED SCH 2023; 90:103-110. [PMID: 36908123 DOI: 10.1272/jnms.jnms.2023_90-116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Abstract
BACKGROUND In vivo three-dimensional (3D) motion under weight-bearing conditions was analyzed postoperatively in medial pivot cruciate-substituting (CS) knee systems with fixed and mobile inserts. METHODS Tibiofemoral knee kinematics during squatting were captured with X-ray fluoroscopy for 4 patients in each cohort. The 3D motion of implants was analyzed with KneeMotion motion analysis software (LEXI Corporation; Tokyo, Japan). In addition, anterior-posterior (AP) movement of the distal-most points and the angle of axial rotation of the femoral component on the tibial component were assessed in both cohorts. RESULTS Mean AP movement of the femoral component on the tibial component was 3.8±0.5 mm on the medial side and 9.5±0.5 mm on the lateral side in the cohort with fixed prostheses and 5.9±2.1 mm on the medial side and 10.0±2.5 mm on the lateral side in the cohort with mobile prostheses. The mean angle of axial rotation of the femoral component on the tibial component was 14.4±1.1 degrees and 8.2±2.7 degrees of external rotation for fixed knees and mobile knees, respectively. CONCLUSIONS Postoperative motion analysis confirmed that fixed and mobile CS implants, which have a similar design, guided medial pivot motion under weight-bearing conditions. However, motion differed between these implant types after mid-flexion: bicondylar rollback after medial pivot motion was noted in the mobile cohort.
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Affiliation(s)
| | - Nobukazu Okimoto
- Department of Orthopaedic Surgery, Shimura Hospital.,Okimoto Clinic
| | - Mikiya Sawa
- Department of Orthopaedic Surgery, Shimura Hospital
| | - Kei Asano
- Department of Orthopaedic Surgery, Shimura Hospital
| | | | - Makoto Kawasaki
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health
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Tanifuji O, Mochizuki T, Sato T, Watanabe S, Omori G, Kawashima H. Mobile medial pivot (lateral slide) type total knee arthroplasty exhibits a medial pivot pattern: three-dimensional motion analysis using cadaveric knees. J Exp Orthop 2022; 9:122. [PMID: 36520362 PMCID: PMC9755420 DOI: 10.1186/s40634-022-00558-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The purpose of this study was to analyze the dynamic kinematics of the mobile medial pivot-type total knee arthroplasty (MMPTKA) using the three-dimensional (3D)-to-2D registration technique. METHODS Cadaveric knees from five humans were used. Computed tomography of the lower limb and preoperative 3D planning for MMPTKA were performed. After performing TKA, passive motion of the knee was observed from a fully extended position to maximum flexion using a flat panel detector. The following parameters were determined: (1) anteroposterior (AP) translations of the medial and lateral most distal points (estimated contact point) of the femoral component, (2) rotational femoral component's X-axis (FCX) angle, and (3) rotational insert angle. Paired t-tests were used to analyze differences in the AP translation between the medial and lateral most distal points of the femoral component as well as differences in the changes in the rotational angle between the FCX and X-axis of the insert on the tibial component's axial plane. RESULTS The AP translations of the femoral component's medial and lateral most distal points were 8.4 ± 2.5 and 13.6 ± 3.3 mm, respectively (p = 0.001). The rotational angles of the FCX and insert were 10.7° ± 4.9° external rotation and 8.9° ± 4.1° internal rotation, respectively (p = 0.004). CONCLUSIONS The posterior translation of the lateral side of the femoral component was greater than that of the medial in all cases. Hence, a medial pivot pattern was identified. The femoral component exhibited external rotation throughout knee flexion in all subjects, whereas the mobile insert exhibited internal rotation (opposite pattern relative to the femoral component). This study provides valuable kinematical information of MMPTKA that has not been clear yet.
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Affiliation(s)
- Osamu Tanifuji
- grid.260975.f0000 0001 0671 5144Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, 1-757 Asahimachi-Dori Chuo-Ku, Niigata, 951-8510 Japan
| | - Tomoharu Mochizuki
- grid.260975.f0000 0001 0671 5144Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, 1-757 Asahimachi-Dori Chuo-Ku, Niigata, 951-8510 Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Satoshi Watanabe
- Department of Orthopaedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Go Omori
- grid.412183.d0000 0004 0635 1290Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Hiroyuki Kawashima
- grid.260975.f0000 0001 0671 5144Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, 1-757 Asahimachi-Dori Chuo-Ku, Niigata, 951-8510 Japan
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Shalhoub S, Cyr A, Maletsky LP. Correlation between knee anatomy and joint laxity using principal component analysis. J Orthop Res 2022; 40:2502-2509. [PMID: 35220608 DOI: 10.1002/jor.25294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 08/04/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
Knee articular geometry and surface morphology greatly affect knee joint mechanics. Intra-subject variations in bone morphology and the passive range of motion have been well documented in the literature; however, the relationship between these two characteristics is not well understood. The objective of this study was to describe the correlation between knee joint anatomical features and passive range of motion using a statistical model. A principal component model was developed using femoral and tibial articular geometry, knee joint initial stance position, and the passive laxity envelope obtained from 27 cadaveric knees. The results from the principal component analysis showed high correlation between the anatomical features and the tibiofemoral passive envelope; an increase in the average femoral condyle radii, an increase in slope of the tibial spine, and a higher tibial plateau concavity correlated with a decrease in varus-valgus and internal-external range of motion. Understanding the correlation between anatomical features and tibiofemoral laxity could aid in the development of orthopedic implant designs by quantifying the effect of perturbing specific anatomical features on knee laxity and identifying specific implant femoral and tibial articular geometry necessary to obtain a targeted passive range of motion.
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Affiliation(s)
- Sami Shalhoub
- Bioengineering Graduate Program, University of Kansas, Lawrence, Kansas, USA
| | - Adam Cyr
- Bioengineering Graduate Program, University of Kansas, Lawrence, Kansas, USA.,Center for Orthopaedic Biomechanics, University of Denver, Denver, Colorado, USA
| | - Lorin P Maletsky
- Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas, USA
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Kahlenberg CA, Chalmers B, Sun HJ, Mayman DJ, Westrich GH, Haas SB, Sculco PK. Polyethylene Components in Primary Total Knee Arthroplasty: A Comprehensive Overview of Fixed Bearing Design Options. J Knee Surg 2022; 35:1401-1408. [PMID: 33618396 DOI: 10.1055/s-0041-1723981] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The articular design of a polyethylene insert influences the kinematics and overall function of a total knee arthroplasty (TKA). Standard symmetric posterior-stabilized and cruciate-retaining polyethylene designs have a long track record of high patient satisfaction and longevity in TKA. However, the number and variety of polyethylene inserts and articulations have continued to evolve in an attempt to better replicate native knee kinematics or provide additional constraint. Ultracongruent polyethylene designs have been touted as increasing stability while maintaining the benefits of cruciate-retaining knees. Medial pivot and lateral/dual pivot polyethylene designs were introduced to mimic more normal knee kinematics with regard to femoral rollback. Further, with increasing recognition of knee instability as a cause for persistent symptoms and revision TKA, the utilization of midlevel constraint polyethylene inserts has been increasing, with multiple implant companies offering an insert design with increased constraint for use with a primary femoral component. In this rapidly evolving arena in with a myriad of options available, surgeons should be knowledgeable about the design concepts and their applicable uses for specific patient scenarios. Future research is needed to better understand whether a particular type or design of polyethylene insert and articulation leads to improved patient reported outcomes, improved replication of knee kinematics, and long-term durable implant survivorship.
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Affiliation(s)
- Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Brian Chalmers
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Hyung Jin Sun
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - David J Mayman
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Steven B Haas
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
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Evaluation of double-high insert mid-term outcomes in cruciate-retaining medial-pivotal total knee arthroplasty - a propensity score-matched analysis with averaged 8-year follow-up. BMC Musculoskelet Disord 2022; 23:571. [PMID: 35701774 PMCID: PMC9195354 DOI: 10.1186/s12891-022-05484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to compare the mid-term clinical and radiographic outcomes between medial-pivotal (MP) insert and double-high (DH) insert used under the cruciate-retaining condition in ADVANCE® total knee arthroplasty (TKA). METHODS The follow-up was conducted for 158 consecutive patients who underwent unilateral ADVANCE® TKA from January 2011 to April 2014. Eighty-four MP inserts and 74 DH inserts were used under cruciate-retaining conditions. A 1:1 propensity score matching (PSM) analysis was performed between MP inserts and DH inserts to compare the clinical and radiographic outcomes. RESULTS After a 1:1 PSM, 120 patients (60 pairs) were matched between the MP and DH inserts groups. The baseline demographic parameters and clinical scores were comparable between the two groups. The postoperative clinical outcomes at an averaged 8-year follow-up of both groups were significantly improved. The range of motion (ROM) of the DH group was better than that of the MP group, and equivalent Knee Society Function Score (KSFS) between the two groups was found. However, the Knee Society Score (KSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and Forgotten Joint Score (FJS) of the MP group were found to be significantly superior to those of the DH group. Comparable complication and revision rates were observed between the two groups. The radiographic results were also equally good between MP and DH groups. CONCLUSIONS Although the mid-term clinical and radiographic outcomes of the DH inserts are fairly good, the clinical scores of the DH group were worse than those of the MP group.
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Ueyama H, Kanemoto N, Minoda Y, Yamamoto N, Taniguchi Y, Nakamura H. No Difference in Postoperative Knee Flexion and Patient Joint Awareness Between Cruciate-Substituting and Cruciate-Retaining Medial Pivot Total Knee Prostheses: A 10-Year Follow-Up Study. J Arthroplasty 2022; 37:279-285. [PMID: 34793858 DOI: 10.1016/j.arth.2021.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to clarify differences in clinical results, including in patients' joint awareness, between cruciate-substituting (CS) and cruciate-retaining (CR) medial pivot total knee arthroplasty (TKA) over a 10-year follow-up. METHODS A total of 333 TKAs were included in this study. There were 257 cases of CS and 76 cases of CR TKAs. Knee range of motion, Knee Society Score, and radiological outcomes were assessed. The patients' joint awareness was evaluated using the Forgotten Joint Score-12 at the final follow-up. The survival rate with respect to reoperation or revision was analyzed. RESULTS The mean follow-up period was 10 ± 1.7 years, and the loss to follow-up was 5.4%. All clinical outcomes improved significantly after surgery in both groups (P < .001). Postoperative knee flexion was 118° ± 13° in the CS group and 116° ± 10° in the CR group (P = .10). The mean Forgotten Joint Score-12 scores were 57 ± 27 points in the CS group and 56 ± 28 points in the CR group (P = .59). Ten years after the operation, the survival rates for reoperation were 96.3% in the CS group and 94.2% in the CR group (P = .61), and those for revision were 98.4% and 98.7% in the CS and CR groups, respectively (P = .87). Other postoperative clinical results did not differ between the 2 groups. CONCLUSION In this 10-year follow-up study, medial pivot TKA, regardless of polyethylene insert type, showed a high survival rate and good patient awareness of the prosthetic joint.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan; Department of Orthopedic Surgery, Tanabe Central Hospital, Tanabe, Wakayama, Japan; Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
| | - Narihiro Kanemoto
- Department of Orthopedic Surgery, Tanabe Central Hospital, Tanabe, Wakayama, Japan
| | - Yukihide Minoda
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
| | - Nobuo Yamamoto
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
| | - Yoshiki Taniguchi
- Department of Orthopedic Surgery, Tanabe Central Hospital, Tanabe, Wakayama, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
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Akti S, Karakus D, Sezgin EA, Cankaya D. No differences in clinical outcomes or isokinetic performance between cruciate-substituting ultra-congruent and posterior stabilized total knee arthroplasties: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2021; 29:3443-3449. [PMID: 32940732 DOI: 10.1007/s00167-020-06275-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/08/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Whether ultra-congruent (UC) or posterior cruciate ligament-stabilized (PS) inserts should be used in posterior cruciate ligament (PCL)-sacrificing total knee arthroplasty (TKA) remains debatable. Therefore, the aim of this prospective randomized controlled study was to compare the isokinetic performance and clinical outcomes of these inserts in PCL-sacrificing TKA. METHODS Sixty-six patients diagnosed with primary knee osteoarthritis were randomly assigned to either the UC or the PS group. There were no significant differences between the groups in terms of age, body mass index or sex. The Knee Society score (KSS) and isokinetic performance results for each patient were recorded preoperatively and at 3, 6 and 12 months postoperatively. The physiatrist that performed the isokinetic tests and the patients were blinded to the study groups. RESULTS There were no significant differences between the groups in terms of the preoperative KSS or isokinetic performance. Gradual improvement in the KSS was observed in both groups, but no significant differences were detected between the groups during the whole follow-up period. The UC and PS groups exhibited similar peak extension and flexion torque values normalized to body weight at 3, 6 and 12 months postoperatively (p > 0.05). CONCLUSION The use of UC or PS inserts in TKA did not affect the clinical outcomes or isokinetic performance.The clinical relevance of this study is that the potential differences in clinical outcomes and isokinetic performance between UC and PS inserts do not need to be considered when sacrificing the PCL in TKA. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Sefa Akti
- Department of Orthopaedic and Traumatology, Aksaray University Education and Research Hospital, Tacin Street, 68120, Aksaray, Turkey.
| | - Dilek Karakus
- Department of Physical Medicine and Rehabilition, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Erdem Aras Sezgin
- Department of Orthopaedic and Traumatology, Aksaray University Education and Research Hospital, Tacin Street, 68120, Aksaray, Turkey
| | - Deniz Cankaya
- Department of Orthopaedic and Traumatology, Aksaray University Education and Research Hospital, Tacin Street, 68120, Aksaray, Turkey
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Sun X, Gao X, Sun X, Su Z. Comparison of clinical and radiographic results between total knee arthroplasties using medial pivot and posterior-stabilized prosthesis: A meta-analysis. Medicine (Baltimore) 2021; 100:e23809. [PMID: 33530177 PMCID: PMC7850707 DOI: 10.1097/md.0000000000023809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 11/19/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To evaluate the clinical and radiographic outcomes of total knee arthroplasties (TKA) between using medial-pivot (MP) and posterior-stabilized (PS) prosthesis. Does MP prosthesis and PS prosthesis influence the clinical results of a TKA? METHODS An electronic literature search of PubMed Medline and the Cochrane Library was performed from inception to October 1, 2019. A meta-analysis to compare postoperative outcomes of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society Score (KSS), range of motion (ROM), complications, and radiographic results between MP and PS prosthesis were conducted. RESULTS Seven eligible studies involving 934 adult patients (MP group, n = 461; PS group, n = 473) were identified for analysis. This study showed no significant difference between the 2 groups in the WOMAC scores, KSS, ROM, and complications (P > .05). The differences of the femorotibial angle, position of implant, and patellar tilt were also not significant between the 2 groups (P > .05). CONCLUSION The present meta-analysis has shown that patients with the MP prosthesis have similar clinical results as patients with PS prosthesis. Furthermore, the radiographic results, especially patella tilt angle, were also similar between the 2 groups. Therefore, surgeons should be aware that the types of prostheses are not a decisive factor to ensure successful operation.
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Affiliation(s)
| | | | | | - Zheng Su
- Department of Medical Oncology, Weifang People's Hospital, Weifang, China
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Kalaai S, van Dun B, Boonen B, van Haaren EH, Schotanus MGM. CR-lipped bearing is an adequate functional solution to patients with perioperative excessive laxity in cruciate retaining total knee arthroplasty. Knee 2021; 28:51-56. [PMID: 33307319 DOI: 10.1016/j.knee.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/06/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The cruciate retaining lipped (CR-lipped) bearing is designed to provide more anterior-posterior (AP) stability and could be employed to resolve excessive intraoperative laxity during the cruciate retaining TKA (CR-TKA). The aim of the study was to determine whether the CR-lipped bearing in CR-TKAs with a perioperative excessive laxity allows equivalent functional results as compared to the standard CR articulation. METHODS A cohort of 111 TKAs with CR-lipped bearings was matched to a cohort of conventional CR bearings regarding age and sex. The CR-lipped bearing was used in patients with excessive knee AP laxity and the regular CR bearing was used in patients without excessive AP laxity during TKA. Various PROMs (WOMAC, KSS, SF-36) were assessed preoperatively and at 5-years postoperative in combination with revision rate and Range of Motion (ROM). RESULTS PROMs did not differ significantly between both groups 5-years postoperatively. Mean ROM (flexion) 5-years postoperatively was not significantly different. The implant survivorship was 100% for both cohorts with revision for any reason as end point. CONCLUSION Based on these results, the CR-lipped bearing is a safe and effective solution for mild interoperatively assessed PCL laxity during CR-TKA without loss of function or decreased survivorship at 5 years. Peroperative conversion to a PS-TKA in order to obtain satisfactory functional scores might therefore not be necessary when mild PCL laxity is observed during surgery. Further research should focus on verifying this approach and longer follow-up is needed to generate data on long term survivorship. LEVEL OF EVIDENCE Level IV therapeutic, retrospective, cohort study.
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Affiliation(s)
- S Kalaai
- Dept. of Orthopaedic Surgery, Zuyderland Medical Centre, Location Sittard-Geleen, the Netherlands.
| | - B van Dun
- Dept. of Orthopaedic Surgery, Zuyderland Medical Centre, Location Sittard-Geleen, the Netherlands.
| | - B Boonen
- Dept. of Orthopaedic Surgery, Zuyderland Medical Centre, Location Sittard-Geleen, the Netherlands.
| | - E H van Haaren
- Dept. of Orthopaedic Surgery, Zuyderland Medical Centre, Location Sittard-Geleen, the Netherlands.
| | - M G M Schotanus
- Dept. of Orthopaedic Surgery, Zuyderland Medical Centre, Location Sittard-Geleen, the Netherlands; School of Care and Public Health Research Institute, Faculty of Health, Medicine & Life Sciences, Maastricht University Medical Centre, P. Debyelaan 25, NL-6202 AZ Maastricht, the Netherlands.
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14
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Affiliation(s)
- N. G. Patel
- Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, UK
| | - H. B. Waterson
- Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, UK
| | - J. R. A. Phillips
- Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, UK
| | - A. D. Toms
- Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, UK
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15
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Pejhan S, Bohm E, Brandt JM, Wyss U. The influence of geometric design variables on the kinematic performance of a surface-guided total knee replacement. J Orthop Surg (Hong Kong) 2018; 25:2309499017727922. [PMID: 28914139 DOI: 10.1177/2309499017727922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Tibiofemoral geometries in a total knee replacement (TKR) affect the performance of an implant during activities of daily living. The specially shaped components of a surface-guided TKR aim to control the tibiofemoral motion, such that a normal pattern of motion is achieved, even at high flexion angles. The purpose of this study was to assess the influence of the design parameters on the kinematic behavior of such an implant. A combination of design variables was determined that resulted in the least deviation from the design kinematic target. METHODS Six major design variables were considered to generate customized surface-guided TKR candidates. The contribution of these variables was evaluated by principal component analysis considering the input design variables and the results of the kinematic performance from a virtual simulation of deep squatting. The tibial internal-external rotation and the anterior-posterior translation of the medial and lateral femoral condyles were recorded for each design candidate. A quantified objective function of the kinematic behavior was used to define the design with a maximum agreement with the target pattern of motion. RESULTS The location and orientation of the flexion-extension axis and the tibial slope were the most contributing parameters on the modes of variation. On the other hand, the conformity between the lateral guiding arcs had the least contribution. CONCLUSION Virtual simulation showed that the current TKR reached deep flexion angles under squat load, while the tibia pivoted around the medial center. The tibial rotation was within the expected range of the IE rotation from healthy joints.
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Affiliation(s)
- Shabnam Pejhan
- 1 Department of Mechanical Engineering, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eric Bohm
- 2 Orthopaedic Innovation Centre, Winnipeg, Manitoba, Canada.,3 Department of Surgery, Section of Orthopedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jan-Mels Brandt
- 1 Department of Mechanical Engineering, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Urs Wyss
- 1 Department of Mechanical Engineering, University of Manitoba, Winnipeg, Manitoba, Canada
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Pejhan S, Bohm E, Brandt JM, Gascoyne T, Wyss U. Kinematic behavior of a customized surface-guided knee implant during simulated knee-bending. Med Eng Phys 2017; 48:168-175. [DOI: 10.1016/j.medengphy.2017.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 06/07/2017] [Accepted: 06/14/2017] [Indexed: 11/27/2022]
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Pejhan S, Bohm E, Brandt JM, Wyss U. Design and virtual evaluation of a customized surface-guided knee implant. Proc Inst Mech Eng H 2016; 230:949-61. [PMID: 27574038 DOI: 10.1177/0954411916663839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/19/2016] [Indexed: 11/16/2022]
Abstract
Although total knee arthroplasty is generally a successful operation, many studies have shown that it results in significant alterations in the kinematics of the joint, which cause limitations in performing the activities of daily living. This study aimed to define the design features for a customized surface-guided total knee replacement and to evaluate the kinematic outcomes. Magnetic resonance imaging data of the knee joint are used to generate the design features as they relate to the functionality of the implant. The motion is guided by considering a partial ball and socket configuration on the medial condyle and varying radii of curvature on the lateral articulating surface. A virtual simulation of the behavior of the surface-guided total knee replacement was performed to investigate the motion patterns of this total knee replacement under gait and squatting loading conditions. Results of the virtual simulation show that flexion and extension of the knee make the center of the lateral condyle move more naturally in the posterior and anterior directions, in comparison to the center of the medial condyle. Such guidance is achieved as a result of the novel customized designed contact between the articulating surfaces. The proposed customized surface-guided total knee replacement provides patterns of motion close to the expected more natural target, not only during a gait cycle but also as the knee flexes to higher degrees during squatting. Major design features include location and orientation of the flexion and pivoting axes, the trace of the contact points on the tibia, and the radii of the guiding arcs on the lateral condyle.
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Affiliation(s)
- Shabnam Pejhan
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Eric Bohm
- Orthopaedic Innovation Centre, Winnipeg, MB, Canada Department of Surgery, Section of Orthopedic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Jan-Mels Brandt
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Urs Wyss
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, MB, Canada Orthopaedic Innovation Centre, Winnipeg, MB, Canada
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Atzori F, Salama W, Sabatini L, Mousa S, Khalefa A. Medial pivot knee in primary total knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:6. [PMID: 26855942 DOI: 10.3978/j.issn.2305-5839.2015.12.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Total knee arthroplasty (TKA) with a medial pivot design was developed in order to mimic normal knee kinematics; the highly congruent medial compartment implant should improve clinical results and decrease contact stresses. Clinical and radiographic mid-term outcomes are satisfactory, but we need other studies to evaluate long-term results and indications for unusual cases.
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Affiliation(s)
- Francesco Atzori
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
| | - Wael Salama
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
| | - Luigi Sabatini
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
| | - Shazly Mousa
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
| | - Abdelrahman Khalefa
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
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Bae DK, Cho SD, Im SK, Song SJ. Comparison of Midterm Clinical and Radiographic Results Between Total Knee Arthroplasties Using Medial Pivot and Posterior-Stabilized Prosthesis-A Matched Pair Analysis. J Arthroplasty 2016; 31:419-24. [PMID: 26482685 DOI: 10.1016/j.arth.2015.09.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/31/2015] [Accepted: 09/15/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite the theoretical advantage of a knee design that can more reliably replicate the medial pivot (MP) of the natural knee, only a few clinical studies have compared the clinical results between the MP prosthesis and another design of prosthesis. We compared the midterm results of total knee arthroplasty (TKA) using an MP prosthesis vs a posterior-stabilized prosthesis via a matched-pair analysis; we included results related to patellofemoral joint symptoms. METHODS The midterm clinical and radiographic results of 125 consecutive patients (150 knees) who underwent a TKA with the ADVANCE MP prosthesis were compared with those of a control group who had undergone a primary TKA with a posterior-stabilized prosthesis. RESULTS Values of the Knee Society's Knee Scoring System, Western Ontario and McMaster Universities Osteoarthritis Index, and Kujala and Feller scoring systems, as well as the range of motion after TKA, did not significantly differ between the 2 groups. No differences in femorotibial angle and component position, including the patella component, were observed between the 2 groups. No significant differences in the change of patella tilt angle and the postoperative patellar translation were observed between the 2 groups. CONCLUSION Patients with the MP prosthesis experienced satisfactory pain relief and a functional recovery, providing results similar to those of the posterior-stabilized prosthesis, including the resolution of patellofemoral joint symptoms.
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Affiliation(s)
- Dae Kyung Bae
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sung Do Cho
- Department of Orthopaedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang Kyu Im
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
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Li C, Hosseini A, Tsai TY, Kwon YM, Li G. Articular contact kinematics of the knee before and after a cruciate retaining total knee arthroplasty. J Orthop Res 2015; 33:349-58. [PMID: 25469483 DOI: 10.1002/jor.22764] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 10/06/2014] [Indexed: 02/04/2023]
Abstract
Accurate knowledge of tibiofemoral articular contact kinematics of the knee after total knee arthroplasty (TKA) is important for understanding the intrinsic knee biomechanics and improving the longevity of the components. The objective of this study was to compare the in vivo articular contact kinematics of the knees with end-stage medial osteoarthritis (OA) during a weight-bearing, single leg lunge activity before and after a posterior cruciate retaining TKA (CR-TKA) using a dual fluoroscopic imaging technique. We found that the CR-TKA resulted in more posterior contact positions on the tibial surface and a reduced range of motion in the medial and lateral compartments. The distances between medial and lateral contact locations in the CR-TKA knees were statistically larger than the OA knees. The articular contact centers have shifted from medial side of the tibial plateau pre-operatively to the lateral side after operation. This study indicated that the CR-TKA resulted in significant changes in contact kinematics of the knees in both anteroposterior and mediolateral directions. Further studies are needed to determine the influence of the altered in vivo contact kinematics on the longevity of polyethylene liner and long term clinical outcomes of the TKA.
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Affiliation(s)
- Chunbao Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, Massachusetts 02114; Department of Orthopaedic Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 1000853, China
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22
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Youm YS, Cho SD, Lee SH, Cho HY. Total Knee Arthroplasty Using a Posterior Cruciate Ligament Sacrificing Medial Pivot Knee: Minimum 5-year Follow-up Results. Knee Surg Relat Res 2014; 26:135-40. [PMID: 25229042 PMCID: PMC4163570 DOI: 10.5792/ksrr.2014.26.3.135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/29/2014] [Accepted: 06/16/2014] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To evaluate minimum 5-year follow-up clinical and radiological results of total knee arthroplasty (TKA) using a posterior cruciate ligament sacrificing (PS), non-substituting Advance Medial Pivot Knee. MATERIALS AND METHODS One hundred and twenty knees in 80 patients who could be followed up for more than 5 years after TKA using the PS Advance Medial Pivot Knee were evaluated retrospectively. The evaluations included the preoperative and postoperative range of motion (ROM), tibiofemoral angle, Knee Society (KS) knee and function scores, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. The Kaplan-Meier method was used for survival analysis. RESULTS The ROM increased from a preoperative mean flexion contracture of 7.6° and further flexion of 115.1° to a postoperative mean flexion contracture of 1.5° and further flexion of 120.5°. The tibiofemoral angle was changed from 4.6° varus preoperatively to 5.8° valgus postoperatively. The KS knee and function scores as well as WOMAC score significantly improved after surgery (p<0.05). Complications developed in 4 cases (3.3%): 2 cases of periprosthetic patellar fracture (1.7%) and 2 cases of aseptic loosening (1.7%). The seven-year survival rate was 98.1% in the Kaplan-Meier survival analysis. CONCLUSIONS The minimum 5-year follow-up results of TKA using the PS Medial Pivot Knee were satisfactory.
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Affiliation(s)
- Yoon-Seok Youm
- Department of Orthopedic Surgery, Arthro-center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sung-Do Cho
- Department of Orthopedic Surgery, Arthro-center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seon-Ho Lee
- Department of Orthopedic Surgery, Arthro-center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hye-Yong Cho
- Department of Orthopedic Surgery, Arthro-center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Wilson DAJ, Astephen Wilson JL, Richardson G, Dunbar MJ. Changes in the functional flexion axis of the knee before and after total knee arthroplasty using a navigation system. J Arthroplasty 2014; 29:1388-93. [PMID: 24836651 DOI: 10.1016/j.arth.2013.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 11/11/2013] [Accepted: 11/26/2013] [Indexed: 02/01/2023] Open
Abstract
Long term satisfaction of patients with total knee arthroplasty (TKA) has lagged behind that of total hip arthroplasty. One possible reason is the failure of the artificial joint to recreate natural kinematics of the knee. This study evaluated the pre and post implant functional flexion axis in the knees of 285 total knee arthroplasty patients using a surgical navigation system. Results showed that post-implant there was less femoral rollback early in flexion on the lateral side of the joint than pre-implant. Designing future generations of knee implants to allow for this motion may give patients a more 'natural' feeling knee and may benefit outcomes.
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Affiliation(s)
- David A J Wilson
- School of Biomedical Engineering, Dalhousie University, Halifax, Canada; Department of Surgery, Dalhousie University, Halifax, Canada
| | | | - Glen Richardson
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - Michael J Dunbar
- School of Biomedical Engineering, Dalhousie University, Halifax, Canada; Department of Surgery, Dalhousie University, Halifax, Canada
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Partial restoration of knee kinematics in severe valgus deformity using the medial-pivot total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014. [PMID: 23188499 DOI: 10.1007/s00167-012-2315-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE The objectives of the study were to examine knee kinematics in knees with severe valgus deformities and to compare pre- and post-operative knee kinematics for the same subjects implanted with medial-pivot total knee arthroplasty (TKA). METHODS Seven subjects with severe valgus deformities due to osteoarthritis (OA) or rheumatoid arthritis (RA) were enrolled in the prospective study. Prior to TKA, three-dimensional (3D) kinematics were assessed by 3D to 2D registration technique using the image matching software 'Knee Motion', under in vivo, weight-bearing conditions. Postoperatively, each subject again performed the same motion under fluoroscopic surveillance. RESULTS Preoperative kinematics demonstrated external rotation of tibias from extension to flexion, and small posterior femoral translations dominated in the medial condyle associated with anterior slides during partial range of motion. Postoperatively, these non-physiological tibial rotations were restored, and most subjects exhibited small internal rotations of tibias. On average, preoperative tibial internal rotation was -4.7° ± 7.6° from full extension to maximum flexion, and the angle was 4.8° ± 3.1° postoperatively (p = 0.01). In addition, small amounts of posterior translation of the lateral condyle and anterior translation of the medial condyle were confirmed in most subjects postoperatively. CONCLUSIONS The study showed that the preoperative kinematic pattern established in severe valgus deformity was different from the physiological knee pattern. In addition, post-operative results suggest that the non-physiological kinematics were partially restored after TKA by using the prosthesis design even in the absence of the posterior cruciate ligament (PCL) and the cam-post mechanism.
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No difference between double-high insert and medial-pivot insert in TKA. Knee Surg Sports Traumatol Arthrosc 2014; 22:576-80. [PMID: 23223966 DOI: 10.1007/s00167-012-2314-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare the clinical midterm results in ADVANCE total knee arthroplasty (TKA) with double-high (DH) insert, with same type implant with medial-pivot (MP) insert. METHOD Forty ADVANCE TKAs were randomly divided into two groups, and two different design insert, DH insert, and MP insert were used in each group. At midterm, 4-5 years after surgery, Knee Society Scores (KSS), Knee Society Functional Scores (KSFS), range of motion (ROM), and UCLA activity score were assessed and reported in this study. RESULTS Midterm clinical results, including ROM and KSS, were comparable with both groups. KSFS and UCLA activity score were equally good between the two groups. CONCLUSION The results in this study revealed equally good clinical results with these types of implants at midterm follow-up, although the significant better ROM has not achieved by using DH insert. We concluded that the selection of inserts only could not achieve the better clinical results, including ROM and activity level in this study. LEVEL OF EVIDENCE Therapeutic studies-investigating the results of treatment, Level II.
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Brinkman JM, Bubra PS, Walker P, Walsh WR, Bruce WJM. Midterm results using a medial pivot total knee replacement compared with the Australian National Joint Replacement Registry data. ANZ J Surg 2013; 84:172-6. [DOI: 10.1111/ans.12428] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Preet Singh Bubra
- Orthopaedic Department; Concord Repatriation and General Hospital; Sydney New South Wales Australia
| | - Peter Walker
- Orthopedics; Hip and Knee Clinic; Sydney New South Wales Australia
| | - William R. Walsh
- Surgical and Orthopaedic Research Laboratory; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Warrick J. M. Bruce
- Orthopedics; Hip and Knee Clinic; Sydney New South Wales Australia
- Concord Clinical School; The University of Sydney; Sydney New South Wales Australia
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Chinzei N, Ishida K, Matsumoto T, Kuroda Y, Kitagawa A, Kuroda R, Akisue T, Nishida K, Kurosaka M, Tsumura N. Evaluation of patellofemoral joint in ADVANCE Medial-pivot total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2013; 38:509-15. [PMID: 23925880 DOI: 10.1007/s00264-013-2043-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 07/17/2013] [Indexed: 01/13/2023]
Abstract
PURPOSE ADVANCE Medial Pivot (MP) (Wright Medical) total knee arthroplasty (TKA) was established to replicate normal tibio-femoral knee joint kinematics, however, its influence on the patello-femoral (PF) joint is unclear. The purpose in this study was to assess the PF joint conditions in Advance MP TKA, via radiography and three-dimensional image-matching software. METHODS Ten subjects with osteoarthritis were treated with the ADVANCE MP TKA. Pre-operatively and one month after surgery, skyline views at 30, 60, and 90° of flexion were taken, and patella shift and tilt were measured. With 2D-3D registration techniques using software, implant orientations were matched with the pre-operative CT and changes in the anterior part of the femoral prosthesis, condylar twist angle (CTA) for femoral rotation, and tibial rotation were evaluated. The relationships between morphological and rotational changes were evaluated. RESULTS There were significant differences in patella tilt at 60° and patella shift at all angles between pre- and post-operation (p < 0.05). No correlation was found between morphological changes in the anterior femur with patella tilt and shift. A positive correlation between postoperative CTA and patella shift at 90° was found (p < 0.05); however, no correlation was found between rotational alignment of the tibial component and patella tilt and shift. CONCLUSIONS ADVANCE MP TKA changed patello-femoral joint kinematics, compared to that found before surgery. The kinematic features were mainly due to the design concepts for tibio-femoral joint motion, indicating the difficulty to reproduce normal patello-femoral joint kinematics after TKA.
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Affiliation(s)
- Nobuaki Chinzei
- Department of Orthopaedic Surgery, Hyogo Rehabilitation Center Hospital, 1070 Akebono-cho, Nishi-ku, Kobe, 651-2181, Japan
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Cho SH, Cho HL, Lee SH, Jin HK. Posterior femoral translation in medial pivot total knee arthroplasty of posterior cruciate ligament retaining type. J Orthop 2013; 10:74-8. [PMID: 24403754 DOI: 10.1016/j.jor.2013.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 04/01/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To report clinical results and demonstrate posterior femoral translation (PFT) in medial pivot total knee arthroplasty (TKA) of posterior cruciate ligament (PCL) retaining type. MATERIALS AND METHODS A prospective study was performed upon thirty consecutive subjects who were operated on with medial pivot TKA of PCL retaining type between March 2009 and March 2010 and had been followed up for at least 2 years. Clinically, the knee society knee score and function score were used. In full extension and active flexion lateral radiograph, anteroposterior (AP) condylar position and magnitude of PFT was determined. RESULTS At last follow-up, the mean knee society knee score and function score improved significantly compared to preoperative scores. The AP condylar positions were consistently posterior to midline throughout the entire range of flexion. The PFTs averaged 0.31 (±0.12) of half length of tibial base plate and were greater in higher flexion cases (r = 0.56, p = 0.0012). There were no cases having either component migration or radiolucent line wider than 2 mm except for one case showing instability related to trauma. CONCLUSIONS In medial pivot TKA of PCL retaining type, clinical outcomes were satisfactory and posterior femoral translations were consistently observed during progressive flexions of knees at two- to three-year follow-up.
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Affiliation(s)
- Su Hyun Cho
- Department of Orthopaedic Surgery, Good Samsun Hospital, Busan 617-718, Republic of Korea
| | - Hyung Lae Cho
- Department of Orthopaedic Surgery, Good Samsun Hospital, Busan 617-718, Republic of Korea
| | - Soo Ho Lee
- Department of Orthopaedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Hong Ki Jin
- Department of Orthopaedic Surgery, Good Samsun Hospital, Busan 617-718, Republic of Korea
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Vecchini E, Christodoulidis A, Magnan B, Ricci M, Regis D, Bartolozzi P. Clinical and radiologic outcomes of total knee arthroplasty using the Advance Medial Pivot prosthesis. A mean 7 years follow-up. Knee 2012; 19:851-5. [PMID: 22571852 DOI: 10.1016/j.knee.2012.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 04/04/2012] [Accepted: 04/05/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medial Pivot total knee prosthesis has been designed according to studies on normal knee kinematics aiming to replicate physiological knee movement. The purpose of this study was to evaluate clinical and radiologic results of the Advance Medial Pivot Total Knee Arthroplasty, at a mean follow-up of seven years. METHODS One hundred seventy two Medial Pivot total knee arthroplasties in 160 consecutive patients have been evaluated using the American Knee Society Score and the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Statistical analysis was performed using the Student's t-test and the Wilcoxon matched-pairs signed-rank (Mann-Whitney) test in order to evaluate the significance of differences within the groups of patients. Patients compliance was 93.75% thus only six patients (3.75%) lost to follow-up and four patients (2.5%) died for reasons unrelated to the surgery. RESULTS The mean Knee Society score and range of motion was improved from 77.6 points and 97.7° to 152.8 points and 112.5° respectively (p<.001). In total 85.8% and 82.4% of the knees had an excellent (≥ 80) or good (70-79) functional and knee scores respectively. Relief of pain was satisfactory in 88.9% of the patients, while 96% of the patients return to age-related daily life activities. Stability and comfort during walking was subjectively judged by the patients as satisfactory in about 90%. Anterior knee pain was observed in eight patients (5.4%). The Kaplan-Meier survivorship analysis showed a cumulative success rate of 98.6%. CONCLUSIONS The results are encouraging but longer follow-up of this cohort is necessary in the study of this specific design. Level of evidence IV.
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Affiliation(s)
- E Vecchini
- Department of Orthopaedics and Traumatology, University of Verona, GB Rossi Hospital, Verona, Italy
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In vivo comparisons of patellofemoral kinematics before and after ADVANCE Medial-Pivot total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2012; 36:2073-7. [PMID: 22885803 DOI: 10.1007/s00264-012-1634-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 07/21/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE ADVANCE Medial-Pivot (MP) (Wright Medical Technology, Arlington, TN, USA) total knee arthroplasty (TKA) was developed to replicate normal tibiofemoral knee joint kinematics, allowing medial-pivot knee motion. The design concept of the prosthesis is unique; therefore, the influence on the patellofemoral knee joint remains unclear at present. The purpose of this study was to determine the in vivo patellofemoral kinematics with ADVANCE MP TKA and compare them with the pre-operative conditions. METHODS ADVANCE MP TKA was performed in ten subjects with osteoarthritis (OA). At before and one month after surgery, lateral radiographs with weight-bearing at maximum extension, 30, 60 and 90° were taken, and patella flexion angle (PF), tibiopatellar angle (TP) and estimated patellofemoral contact point (PC) were evaluated, according to a previously reported method. RESULTS In PF and TP, there was no statistically significant change between pre-operative and postoperative values. Pre-operative PC reached its peak at 90°; however, its peak was at 60° at one month after surgery. Postoperative PC at maximum extension was significantly higher compared to before surgery. CONCLUSIONS The results in this study indicated that ADVANCE MP TKA changed patellofemoral joint kinematics compared to before surgery. Early postoperative evaluation is the limitation of this study; however, we consider that the results in this study might be one of the keys to resolving the kinematic features of this prosthesis, helping clinicians to comprehend this prosthesis.
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